Bitot's spots, dry eyes, and night blindness indicate vitamin A deficiency

Immunohistochemistry in an Adult Case of Bitot's Spots Caused by Vitamin A Deficiency

Bitot's spots (BS) are the buildup of superficially located keratin in the conjunctiva and are early indicators of vitamin A deficiency (VAD), primarily due to malnutrition and malabsorption, thus leading to xerophthalmia. BS are particularly prevalent in developing countries, and their presence necessitates prompt vitamin A supplementation to avert blindness, with the immunohistochemical characteristics of BS aiding in understanding the extent of epithelial abnormalities and the efficacy of vitamin A supplementation. We describe the case of a 34-year-old male with persistent BS despite extensive vitamin A supplementation and topical treatments who underwent surgical excision of the BS followed by amniotic membrane transplantation, thus resulting in symptom relief and epithelialization, with no recurrence observed during follow-up. Histopathologic and immunohistochemical evaluations revealed expression of keratinization-related proteins, along with an absence of mucin-5AC-positive cells, suggesting impaired differentiation into goblet cells due to VAD. This case highlights the potential age-related disparity in the efficacy of vitamin A supplementation, emphasizing the need for early detection and a multidisciplinary approach in the management of VAD, especially in young adults. The favorable outcome of surgical intervention highlights its viability in the management of persistent BS and encourages further investigation to optimize therapeutic strategies for VAD-related ocular manifestations.

Aquaporins in lacrimal glands and their role in dry eye disease

Aging is the most important known risk factor for dry eye is aging, which is associated with changes in the structure and function of the lacrimal gland (LG) and characterized by atrophy, duct blocking lymphocyte infiltration, and reduced protein secretion. Aquaporins (AQP) have been proposed as a potential producer of exocrine gland fluids since exocrine secretion depends on the mobility of water. Therefore, the main topics of this review will be the expression, localization, and function of AQPs in LG. In addition, we review the mechanisms of fluid transport in exocrine gland fluid secretion and discuss the potential role of AQPs in dry eye.

Effect of multivitamin drug on intractable dry eye symptoms

Dry eye is a disorder of tear film and ocular surface characterized by ocular discomforts. It is associated with multiple causes and sometimes intractable. We investigated the effect of oral multivitamin supplementation (MVG) on dry eyes. Tear break-up time (TBUT), fluorescein ocular surface staining score, and tear secretion Schirmer test were measured in dry eye patients refractory to conventional topical treatment. The ocular surface disease index (OSDI), visual analog pain score (VAS), and modified standardized patient evaluation of eye dryness questionnaire were analyzed. In total, 42 eyes of 42 patients were included. TBUT increased at 1 and 3 months compared to baseline (p < 0.05). OSDI decreased at 1 and 3 months compared to baseline (p < 0.05). VAS score, impact on life, and frequency of total symptoms decreased at 3 months compared to baseline (p < 0.05). Oral administration of MVG, a vitamin complex formulation, was effective in stabilizing tear stability and alleviating symptoms in patients with intractable dry eye. Thus, it may be a viable treatment option for intractable dry eye.

Vitamin A, systemic T-cells, and the eye: Focus on degenerative retinal disease

The first discovered vitamin, vitamin A, exists in a range of forms, primarily retinoids and provitamin carotenoids. The bioactive forms of vitamin A, retinol and retinoic acid, have many critical functions in body systems including the eye and immune system. Vitamin A deficiency is associated with dysfunctional immunity, and presents clinically as a characteristic ocular syndrome, xerophthalmia. The immune functions of vitamin A extend to the gut, where microbiome interactions and nutritional retinoids and carotenoids contribute to the balance of T cell differentiation, thereby determining immune status and contributing to inflammatory disease around the whole body. In the eye, degenerative conditions affecting the retina and uvea are influenced by vitamin A. Stargardt’s disease (STGD1; MIM 248200) is characterised by bisretinoid deposits such as lipofuscin, produced by retinal photoreceptors as they use and recycle a vitamin A-derived chromophore. Age-related macular degeneration features comparable retinal deposits, such as drusen featuring lipofuscin accumulation; and is characterised by parainflammatory processes. We hypothesise that local parainflammatory processes secondary to lipofuscin deposition in the retina are mediated by T cells interacting with dietary vitamin A derivatives and the gut microbiome, and outline the current evidence for this. No cures exist for Stargardt’s or age-related macular degeneration, but many vitamin A-based therapeutic approaches have been or are being trialled. The relationship between vitamin A’s functions in systemic immunology and the eye could be further exploited, and further research may seek to leverage the interactions of the gut-eye immunological axis.

Light Perception Vision and Xerophthalmia in an 11-Year-Old Boy

The authors present a case of a child who had severe dietary restriction with consumption of french fries only. He presented to the ophthalmology clinic with light perception vision in both eyes, and was found to have dry, leathery conjunctivae with Bitot's spots and hazy corneas with diffuse punctate epithelial erosions. Electroretinography testing showed an absent rod response and a decreased cone response. Laboratory testing results were positive for vitamin A deficiency. After prompt initiation of treatment, he had improvement in his vision and anterior segment findings. This case serves as a reminder that vitamin A deficiency can present in high-income countries, and that ophthalmologists may play a key role in diagnosing the condition, initiating treatment, and sending patients to the appropriate subspecialists for further evaluation and management of the underlying condition. For patients with vitamin A deficiency, ophthalmologists can play an essential role in preventing permanent vision loss and the systemic consequences of deficiency such as infection or death. [J Pediatric Opthalmology & Strabismus. 2022;59(3):e35-e38.].